The Center for Global Health & Development seeks to conduct high-quality applied research, and to advocate for the use of this research to improve the health of underserved populations around the world. Through our collaborations with scientists worldwide, we also work to strengthen individual and institutional capacity to conduct and utilize research. Here are some examples of the ways our work has improved programming, influenced policy, and stimulated further research.
Helping Children Survive Pneumonia
In a series of landmark studies over the last ten years, CGHD researchers demonstrated that treating children with severe pneumonia at home with oral antibiotics is just as safe and effective as treating them in clinics. This led the World Health Organization to develop new guidelines, saving thousands of lives each year.
Pneumonia is the largest single killer of children under the age of five worldwide. For many years, WHO guidelines for the treatment of severe pneumonia in young children recommended referring patients to a health clinic for intravenous antibiotic treatment. However, for parents in developing countries, seeking treatment for their children at a health care facility is often logistically and financially problematic. Families often lack the resources to transport a child to a distant health facility or to pay for the higher cost of hospitalization. Transport to a distant facility entails serious delays to effective treatment. Because of pressing family duties, the primary caretaker may not be able or willing to accompany and attend a child’s hospital stay, as is so often necessary in developing areas. In a series of landmark studies over the last ten years, CGHD researchers demonstrated that treating children with severe pneumonia at home with oral antibiotics is just as safe and effective as treating them in clinics. Based on these findings, in 2008 the WHO revised its guidelines
for treatment of children with severe pneumonia. In the future, pending the results of another CGHD study involving community health workers in Pakistan, the WHO is expected to consider recommending that these workers diagnose and treat cases of severe pneumonia.
Exclusive Breastfeeding and HIV
Findings from the CGHD’s Zambia Exclusive Breastfeeding Study (ZEBS) were key to the 2006 revision of the World Health Organization Interagency Task Team’s global guidelines on HIV and Infant Feeding.
Breastfeeding presents a very difficult dilemma for HIV-infected mothers in low-resource areas. While it is clearly an essential source of optimal nutrition and offers critical immunologic protection against a wide array of potentially lethal diseases, it can also transmit HIV infection to the child. The competing risks between these two approaches were not previously known and are essential to health care policymakers in making informed decisions about infant nutrition in areas of high HIV prevalence. The CGHD’s Zambia Exclusive Breastfeeding Study
, which began in 2001, was a rigorously designed study that confirmed the observation that exclusive breastfeeding transmitted fewer infections than mixed feeding. It also established that early and abrupt weaning was not effective in reducing the number of children who remained alive and HIV-free by 2 years of age. The findings from the ZEBS study were a key contributor to the 2006 revision of the World Health Organization Interagency Task Team’s global guidelines on HIV and Infant Feeding, which recommended exclusive breastfeeding to 6 months of age and the subsequent continuation of breastfeeding in conjunction with complementary food.
Transforming Lives for Pennies a Day in Malawi
The CGHD’s evaluation of Malawi’s Social Cash Transfer program provided a rationale for the government of Malawi to extend its poverty alleviation program to six more districts, with plans to expand to all of Malawi’s 28 districts by 2012.
In the Mchinji district of Malawi, a country with one of the world’s highest burdens of poverty, an innovative, Social Cash Transfer program provides grants of roughly $13 a month to the poorest households to improve nutrition, health, and education and jumpstart economic development. The CGHD’s Candace Miller
worked with local researchers to evaluate the impacts, targeting, and implementation of this program. The resulting report systematically detailed the program’s strengths, and also offered suggestions for improvement. These findings had far-reaching impact both in Malawi and throughout Africa. They provided a rationale for the government of Malawi to extend the program to six more districts with tentative plans to expand to all of Malawi’s 28 districts by 2012. In addition, the team’s evaluations have attracted interest from policymakers in other African countries, who have pledged to develop similar cash transfer programs.
Doubling the Antiretroviral Treatment Budget in South Africa
Economic projections from CGHD researchers enabled the South African government to commit to the necessary increases in the national ART budget and to adopt a new set of ART guidelines which will double the number of patients in treatment over the next three years.
With more than a million people currently on antiretroviral treatment (ART), South Africa has the world’s largest ART program, as well as the largest number of people in need of ART. Due to the exceptional growth of the program, financial and human resources were put under tremendous strain. To deal with this, the South African Department of Health asked CGHD researchers in Johannesburg to help project the future costs of the program. Pulling together a variety of data, the group analyzed the incidence of side effects, mortality, loss to follow-up, and treatment failure in adult and child patients, and was able to build a stable health-state transition model that could be easily modified to answer all questions the Department of Health needed answered. The group’s findings
enabled the government to commit both to a new set of ART guidelines, which are set to double the number of patients in treatment over the next three years, as well as to the necessary increases in the national ART budget.
Retaining Patients in AIDS Treatment Programs
The CGHD brought the widespread problem of retention in AIDS treatment programs to the attention of researchers and program managers in a landmark paper published in PLoS Medicine in 2007. The paper’s conclusions led to a flurry of studies and interventions aimed at helping patients remain in care.
During the early years of the rapid scale-up of HIV/AIDS treatment programs in sub-Saharan Africa, the attention of policy makers, program managers, and international funders focused almost exclusively on increasing the number of patients newly started on antiretroviral therapy. As reports began to emerge about program results, however, CGHD researchers noticed that a significant number of patients were classified as “lost to follow-up” within the first year or two, and that little was known about their status or characteristics. In a landmark paper
published in PLoS Medicine
in 2007, CGHD authors reviewed reports of 33 patient cohorts in Africa and found that attrition from treatment programs due to loss to follow-up or death averaged 25% after one year and 40% after two years. This paper, which has been cited more than a hundred times and highlighted in a 2009 World Health Organization report
, brought the problem of retention in treatment to the attention of researchers and program managers globally and led to a flurry of studies and interventions aimed at helping patients remain in care.
Community Management of Malaria and Pneumonia in Zambia
CGHD researchers found that trained community health workers can effectively treat pneumonia and malaria. As a result, Zambia is currently scaling up the use of rapid diagnostic tests and anti-malarial drugs administered by community health workers and integrating pneumonia treatment into community management of malaria programs.
Malaria and pneumonia are two of the leading causes of death among children under age five in sub-Saharan Africa. In an effort to improve the treatment for these diseases, the CGHD, in partnership with the Zambian Ministry of Health, launched the Zambia Integrated Management of Malaria and Pneumonia Study
(ZIMMAPS) in 2006. The study’s objective was to determine if community health workers are able to accurately diagnose and treat both malaria and pneumonia with the aid of rapid diagnostic tests. CGHD researchers found that community health workers, with proper training and support, could effectively treat pneumonia and malaria. As a result, Zambia is currently scaling up the use of rapid diagnostic tests and anti-malarial drugs administered by community health workers, as well as integrating pneumonia treatment into existing community management of malaria. The study’s findings were published in PLOS Medicine
in September 2010, and should be of interest to the World Health Organization, as well as the health ministries and nongovernmental organizations involved in child health throughout sub-Saharan Africa.